Validation of Administrative Codes for Palliative Care Consultation Among Critically Ill Children

OBJECTIVES: To determine the validity of palliative care (PC) administrative codes (V66.7 and Z51.5) among critically ill pediatric patients. METHODS: In this single-center retrospective cohort study, we included all hospitalizations with a PICU admission between March 2016 and March 2018. Sensitivity, specificity, and positive and negative predictive values of the relevant codes were estimated by using a gold standard of a local PC registry. RESULTS: During the study period, 4670 hospitalizations were included. The median admission age was 5 years (interquartile range 1.5–12.9) with 55% having at least 1 complex chronic condition. The median length of PICU stay was 1.8 days (interquartile range 1–3.4) and mortality was low (1.3%). A total 182 (3.9%) hospitalizations had evidence of a PC consultation. Administrative codes for PC had a sensitivity of 11% (95% confidence interval [CI] 6.8%–16.5%) and a specificity of 99.8% (95% CI 99.6%–99.9%). The positive and negative predictive values were 66.7% (95% CI 47.2%–82.7%) and 96.5% (95% CI 95.9%–97.0%), respectively. CONCLUSIONS: Among critically ill children, PC administrative codes had high specificity but poor sensitivity. The potential for underascertainment of this resource should be considered in future research using administrative data.